Much has been made of the looming shortage of physicians. But there’s one place where the shortage is being felt acutely, is talked about even less, and the effects will ripple far into the future: the founding of new biomedical startups.
We live at a time when technology is dramatically transforming not just the field of biology but how biology-driven companies are built. It’s now entirely possible to create innovative and scalable new companies in the field with relatively modest initial funding. In other words, it’s salad days to be a bio startup, with so many new tools, data sources, and ideas at our disposal.
Yet there’s a moment of failure that crushes many such startups: when the new tool or technology connects with the real world of patients, physicians, medical records, hospitals, and insurers. That’s when a physician who can navigate the nuances of the medical landscape is needed: one with an innovative mindset who can explain how the new product will function in the system, or touch a patient’s life, or integrate into a doctor’s day. For many startups, finding that person is the hardest personnel problem to solve.
The input and direction that practicing physicians can add to biomedical startups is invaluable. Beyond clarifying how a new technology or product might affect the current health care system, their experience in the clinic and with the health care system provides key insights into company strategy, direction, and growth. Physicians often have the answers to essential questions such as: What are the logistical challenges of how health care is delivered? What are the financial incentives for providers? Who “controls” access to patients — and their lab samples — for clinical studies and for patient care? How do we align the interests of providers and patients, so these innovations make sense for both?
Equally invaluable are their lived experiences as physicians. These can help shape the development and validation of assays for patient care, along with a host of regulatory requirements. These experiences also help them understand the difference between technological capability (can we do it?) versus a clinically unmet need (should we do it?).
Without physician innovators as part of the creative team, many potential innovations will die in the cradle. Applying novel technologies to creating new therapies, preventing illness, and reducing health care costs requires connecting these technologies with patients and the realities of the health care system. And that requires a physician’s mindset, training, and experience
The lack of physician innovators becomes all too visible as new companies grow and the rubber hits the road. All too often, new entries to the market lack a clear understanding of the clinical needs at the patient-physician level, or address an administrative challenge instead of a patient problem. The result is a hodgepodge of products rather than a system of mutually supportive and well-integrated ones, which in turn leads to inefficient systems in the health care system writ large.
Take, for example, that fact that for each hour physicians spend face to face with patients, they now spend two hours on administrative burdens such as data entry, accessing multiple portals, and the like. When innovation connects to clinical care, seasoning teams with physician innovators is required to make sure that everyone understands how new products will work in the real world and don’t add to doctors’ administrative burdens.
There are several reasons why it is hard to find physicians willing to make the jump to startups. One is that doctors are trained to assimilate knowledge and be conservative in treatment choices. Taught from day 1 to “first do no harm,” they tend to take only highly calculated risks. Physicians are trained to be cautious, not disruptive; to follow strict, evidence-based patterns of reason, not take shortcuts; and to be guided by the consensus of well-tested research, not necessarily a new and perhaps yet-to-be tested innovation.
To go from that mindset into creating a company around an untested new therapeutic, tool, or approach requires a major mental leap.
There are also practical limitations to shifting from working as a physician seeing patients to working with a new bio startup. While many physicians are located in natural startup hubs such as San Francisco and Boston — which work because of the strong network effect, built over time, of academia, talent, founders, early venture capital, and follow-on investors — most are not. There are also the certainties of having built a career in medicine. For physicians, the path from medical school to clinical practice is very clear. That’s one of the upsides. The downside is the accumulation of substantial debt while deferring income in order to build a medical practice and acquire expertise. That isn’t compatible with the uncertainties of being part of a startup with the specter of failure.
In Silicon Valley, there’s no dishonor to being part of a failed startup. That’s not the case in medicine, when a patient’s health or life is at stake.
Moving from the clinic to a startup also requires a mindset shift of scale and chronology. People generally go into medicine to treat individual patients. One study showed that the single greatest source of satisfaction driving physicians is the amount of direct face-to-face contact they have with individual patients. Physicians working in startups, by contrast, don’t see individual patients, which can seem out of alignment with the reason they began medical training. Yet they can play a part in treating millions of them. Such indirect contributions can feel less powerful and more detached, despite having an effect that can be substantially greater in scale.
That’s another shift — in aspiration, gratification, and ego — that physician innovators may need to acclimate to. The reward of helping build a company that touches not just hundreds but potentially millions of lives scales one physician’s experience and skills into a superpower of reach. The potential upshot from what could be done is enormous in terms of its impact on population health and therefore productivity of societies.
So how can we join the two worlds of medicine and biomedicine startups? In fact, there’s already plenty of overlap. Culture, for one: Physicians and startup founders share an intense, highly driven work ethic, strong attentiveness to detail, and a sense of wanting to belong to a community that drives toward completing a challenging mission. And the same forces that provide the geographic gravitational pull of physicians can also be hotbeds of technology startups. This can create a powerful confluence of skilled physicians and innovators building companies from the ground up.
There are increasing signs that physicians are intrigued by the prospect of interacting with innovators and startup founders. The American Medical Association’s Physician Innovation Network has built an online community of physicians seeking to collaborate with entrepreneurs that has grown in a short time to more than 4,000 members. In Silicon Valley, the AMA-founded Health2047 is driving innovation by connecting a network of entrepreneurs, corporate partners, and physicians from across medicine to identify critical health issues and develop solutions. Two companies have already been spun off, and more are in the pipeline.
And in much the same way that new bioengineering departments have begun to spring up to support the study of new fields, medical schools such as the Dell Medical School at University of Texas, Austin, or Sidney Kimmel Medical College at Jefferson University in Philadelphia are now embedding a focus on innovation and entrepreneurship into their curricula. We’re seeing more clinician founders starting companies; chief medical officers coming on board at earlier stages of company growth; and physicians embedded in essential roles in companies small and large.
We are on the cusp of a new generation of tech companies being built to improve health and health care. They need physicians to interface with patients, physicians, and the entire health care system. Defining projects, running clinical trials and making sure they are compliant and valid, and understanding a therapeutic or diagnostic and how it can be employed — these are the junctures at which startups succeed or fail. In the past, scant input by physician innovators often led to failure, or resulted in products, tools, and services that were suboptimal.
We need to better connect ideas to products that will have real and beneficial effects. Physician innovators are the only way to truly bridge the two.
Vijay Pande, Ph.D., is a general partner at Andreessen Horowitz, a Silicon Valley venture capital firm. James L. Madara, M.D., is executive vice president and CEO of the American Medical Association and chairman of the board for Health2047, a business formation and commercialization enterprise focused on health care.
I am a retired Board Certified neurosurgeon, with experiences as
chief of staff, trustee and the clinical director of tertiary institution with level I Trauma Center, past president of a State Medical Association, chairman of its delegation to the American Medical Association, founding secretary of AMA IMG section and Clinical Professor of the Neurosurgery. Where can I fit into this future?
I very much appreciate and agree with your comments. As a practicing physician and active consultant to several VCs and medical device startups over the years I have too often seen wonderful feats of engineering with little clinical relevance. I am also acutely aware that while physicians are smart folks, virtually none are actually inventors. We need our brilliant engineer friends to bring insights into reality.
1) Many major healthcare systems that employ physicians as well as regulatory agencies strongly discourage interaction with industry. While lip service is paid to to supporting innovation, the reality is limited ownership of IP, unbalanced sharing of potential upside, and moral shame/potential disciplinary action in the name of avoiding conflicts of interest.
2) As mentioned in the article, physicians often have significant debt, have started their income stream late, and frankly often live dependent on a regular paycheck. The uncertainty of income in the startup world can be incompatible with this. I would encourage the business community to offer higher levels of regular income, potentially with less emphasis on future upside, in order to allow us to transition into the business world and continue to pay our mortgages.
I would appreciate hearing your thoughts on these issues.
I am a physician very much interested in entrepreneurship and innovation and have often felt like a foreign body in health care organizations resistant to change. For the last year I have been networking in the health start up and health tech world’s but believe because I am not connected to Silicon Valley, trained at Stanford, USCF, Harvard and the like, beyond a casual conversation I am not invited into these networks. Nor is it clear to us how to penetrate these networks if we don’t know someone who can endorse us or recognize our potential contributions and expertise despite not attending Ivy League institutions. I believe there are many entrepreneurial physicians who can add tremendous value to these conversations. Can you help us get connected?
When I was a chairman of a department of family/preventive medicine, I was on the top of my academic track, respected and well paid. I didn’t want to go into a venture where I’d start at the bottom. That was what was keeping me from making the transition. After I left my position, I didn’t know where to go to find opportunities in start ups. I retired and still don’t know if there is any interest in making use of my skills. Just want to let recruiters there is a cadre of active and retired academicians available to aid in the issues mentioned in the article.
Hello, I am a soon to be Registered Nurse and I have been trying to develop a new business model of how to care for patients in nursing homes. I would like to offer a more enhanced way of monitoring patients and keeping track of realtime signs and symptoms. This will help give their loved ones more assurance, and help to prevent most injuries before they occur.
a: if a drug actually works, it will find a way by itself
b: a MD in a biotech company is nothing more than a fixer, a middleman, to navigate the bureaucracy and social structure of medical organizations and oil the right spots
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